三维体积法定量评估内镜下微创颈椎管成形和保守治疗后突出椎间盘的再吸收现象  

Cervical microendoscopic laminoplasty and intervertebral disc resorption after conservative treatment assessed with three-dimensional volume method

作　　者：张春霖[1] 赵晓 严旭[1] 宁永明[1] 曹争明 Zhang Chunlin;Zhao Xiao;Yan Xu;Ning Yongming;Cao Zhengming(Department of Orthopedics,First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,Henan Province,China)

机构地区：[1]郑州大学第一附属医院骨科,河南省郑州市450000

出　　处：《中国组织工程研究》2021年第30期4774-4780,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景:在对内镜下微创颈椎管成形治疗后患者的随访中,观察到突出的颈椎间盘多数体积自发缩小,这种普遍出现的突出椎间盘再吸收现象引起了关注。目的:采用影像归档和通信系统软件三维体积法测量内镜下微创颈椎管成形和保守治疗后患者的颈椎间盘突出体积变化,并进行对比分析,探讨发生突出椎间盘再吸收现象的特点及临床意义。方法:回顾性分析郑州大学第一附属医院骨科2014年1月至2018年6月收治的退行性颈椎病患者68例的病历资料,均具有手术指征,其中35例接受内镜下微创颈椎管成形治疗,33例因惧怕手术坚持保守治疗者。应用影像归档和通信系统软件三维体积法测量并分析两组患者颈椎间盘突出的体积变化,用突出颈椎间盘的吸收比和吸收率、再突出比和再突出率等指标评价测量结果,以影像归档和通信系统软件测量的最大误差率5%为颈椎间盘突出测量误差参照标准;应用Odom评分评价保守治疗和手术治疗的临床疗效。结果与结论:(1)内镜下微创颈椎管成形组随访时间7-76个月,35例患者共有122个突出颈椎间盘,其中91个发生突出椎间盘吸收,吸收比为74.6%(91/122),吸收率为5%-100%;统计学分析结果显示,颈椎任意两节段突出椎间盘、中央型与旁侧型、包容型与破裂型之间的吸收比差异无显著性意义(P>0.05)。另有17个椎间盘再突出,再突出比为13.9%,再突出率为5.0%-48.0%。内镜下微创颈椎管成形组最早术后7 d、最晚术后76个月仍可见突出椎间盘再吸收现象。(2)保守治疗组随访时间2-60个月,33例患者共有105个突出颈椎间盘,未观察到突出椎间盘再吸收的现象;另有57个椎间盘再突出,再突出比为54.3%,再突出率为5.0%-80.3%。(3)末次随访内镜下微创颈椎管成形组临床疗效优良率为83%,保守治疗组为36%,两组优良率相比差异有显著性意义(P<0.01)。(4)内镜下微创颈椎管成形手BACKGROUND:In the follow-up of patients after cervical microendoscopic laminoplasty,we observed that most of the herniated cervical discs decreased spontaneously.The resorption of herniated nucleus pulposus phenomenon has attracted our attention.OBJECTIVE:To measure and compare the volume changes of patients with herniated cervical discs after cervical microendoscopic laminoplasty and conservative treatment using picture archiving and communication systems software three-dimensional volume method,and to discuss the characteristics and clinical significance of the resorption of herniated nucleus pulposus phenomenon.METHODS:A retrospective analysis of 68 patients with degenerative cervical spondylosis from January 2014 to June 2018 in the Department of Orthopedics,the First Affiliated Hospital of Zheng University(all had surgical indications)was conducted.Thirty-five people received cervical microendoscopic laminoplasty surgery,and 33 people insisted on conservative treatment for fear of surgery.The volume changes of herniated cervical discs patients in the two groups were measured and analyzed by picture archiving and communication systems software and three-dimensional volume method.The measurement results were evaluated with indexes such as the absorption ratio and absorption rate of the herniated cervical intervertebral disc,the re-protrusion ratio and the reprotrusion rate.The maximum error rate of 5%measured by picture archiving and communication systems software was taken as the reference standard of measurement error of cervical disc herniation.The Odom score was used to evaluate the clinical efficacy of conservative treatment and surgical treatment.RESULTS AND CONCLUSION:(1)The follow-up time in the cervical microendoscopic laminoplasty group was 7-76 months.There were 122 herniated cervical discs in 35 patients,91 of them were absorbed by herniated intervertebral disc,and the absorption ratio was 74.6%(91/122)and the absorption rate was 5%-100%.Statistical analysis showed that there was no significant dif

关 键 词：退行性颈椎病 微创 椎管成形 保守治疗 突出椎间盘再吸收 三维体积测量法 

分 类 号：R459.9[医药卫生—治疗学] R394.2[医药卫生—临床医学]